Provider Demographics
NPI:1568472447
Name:CLOUGH, JEFFREY T (PT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:T
Last Name:CLOUGH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 COMMERICAL ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301
Mailing Address - Country:US
Mailing Address - Phone:603-225-5132
Mailing Address - Fax:603-225-6061
Practice Address - Street 1:28 COMMERICAL ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-225-5132
Practice Address - Fax:603-225-6061
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0654208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30391170Medicaid
NH536232OtherCIGNA
NH0806042Y0NH01OtherANTHEM
NH0806042Y0NH01OtherANTHEM